Laparoscopic Versus Open Retrorectus Mesh Repair of Incisional and Ventral Hernia: A Randomised Clinical Study

Abstract

Introduction: Hernias are defects or holes in the abdominal wall with protrusion of abdominal contents and are common problems in daily surgical practice. The defects can develop following previous surgical procedure or can be primary in the absence of any past surgery. The operative repair of these hernias can be done by either open procedure or laparoscopic surgery. Aim: To compare the laparoscopic hernia repair with open surgical repair in terms of operative time, hospital stay, pain, complications, cost and recurrence. Materials and Methods: This randomised clinical study was conducted from April 2015 to December 2019. Patients undergoing elective surgery for primary ventral hernias and incisional hernias were included. There were 50 patients who underwent open mesh repair and 50 patients who had laparoscopic repair. The data was analysed using Mann-Whitney U test for continuous variables and Chi-square test for categorical variables. Results: The patients were comparable for age and sex distribution and also the type of hernia, primary ventral or incisional, size of defect and body mass index in both the groups. The patients undergoing laparoscopic mesh repair had significantly less operative time (90 vs 110 minutes, p=0.036), reduced postoperative pain (p=0.001) and decreased hospital stay (3.47 vs 6.43 days p=0.0005). The cost of the laparoscopic surgery was significantly high (p-value 0.0001) basically owing to the cost of mesh and disposable tacker. The recurrence at mean follow-up of 13 months was similar in both the groups. Conclusion: Laparoscopic hernia repair is superior to open repair in select group of patients with small and medium size defects without loss of abdominal domain if cost is not a consideration.